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NPI Code Detail

MEDICARE: JAMIE RAE FROST BCBA

MEDICARE: JAMIE RAE FROST BCBA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103K00000XBehavior Analyst187-140WI

General Provider Information

NPI Number : 1356864367
Entity Type Code : Individual
Provider Name (Legal Business Name) : JAMIE RAE FROST BCBA
Provider Business Mailing Address
First Line : N27W23953 PAUL RD STE 206
Second Line :
City : PEWAUKEE
State : WI
Zip : 53072-6244
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 13100 W LISBON RD STE 600
Second Line :
City : BROOKFIELD
State : WI
Zip : 53005-2509
Country : US
Telephone Number : 414-207-4175
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/21/2017
Last Update Date : 10/11/2024

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Directions to “ JAMIE RAE FROST BCBA” Practice Location

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